Cesarean scar ectopic pregnancy
- Authors: Sulima A.N.1, Bakharovskaya A.S.1
-
Affiliations:
- V.I. Vernadsky Federal Crimean University
- Issue: No 9 (2024)
- Pages: 174-179
- Section: Guidelines for the Practitioner
- URL: https://journal-vniispk.ru/0300-9092/article/view/269343
- DOI: https://doi.org/10.18565/aig.2024.145
- ID: 269343
Cite item
Open Access
Access granted
Subscription Access
Abstract
Cesarean scar ectopic pregnancy (CSEP) is a rare type of ectopic pregnancy when the fetal egg attaches to the scar tissue of the uterus after a previous cesarean section (CS).
This review presents the data on the etiology, pathogenesis and incidence of CSEP. The present study analyzed the risk factors associated with CS surgery and invasive procedures within the uterine cavity following CS. The morphologic forms of CSEP are described. Current methods for diagnosing and treating CSEP with their advantages and disadvantages are presented. The most frequent diagnoses observed in CSEP are vaginal bleeding, large masses on the anterior surface of the uterus, cervico-isthmic pregnancy, missed miscarriage with low location of the fetal egg, incomplete abortion, etc. These findings were obtained from a review of medical literature. This paper describes the complications of this pathology, the most common of which is profuse bleeding. It also studies preventive measures and methods of rehabilitation for this type of ectopic pregnancy.
Conclusion: CSEP is a rare but potentially life-threatening complication following CS. Understanding the etiology and pathogenesis of this condition should be relevant today for a practicing obstetrician-gynecologist and doctors of other specialties. Therefore, it is essential to ensure the accuracy of pregnancy diagnosis, minimize performing unreasonable CS, provide reliable treatment, and be sure to carry out rehabilitation after CSEP.
Keywords
Full Text
##article.viewOnOriginalSite##About the authors
Anna N. Sulima
V.I. Vernadsky Federal Crimean University
Author for correspondence.
Email: gsulima@yandex.ru
ORCID iD: 0000-0002-2671-6985
Dr. Med. Sci., Professor, Professor of the Department of Obstetrics, Gynecology and Perinatology № 1, Order of the Labor Red Banner Medical Institute named after S. I. Georgievsky
Russian Federation, SimferopolAnastasiya S. Bakharovskaya
V.I. Vernadsky Federal Crimean University
Email: nastyabakharovskaya@gmail.com
ORCID iD: 0009-0002-1489-0289
student at the Department of Obstetrics, Gynecology and Perinatology № 1, Order of the Labor Red Banner Medical Institute named after S.I. Georgievsky
Russian Federation, SimferopolReferences
- Hong S.C. Ectopic pregnancy in previous Caesarean section scar. Singapore Med. J. 2011; 52(6): e115-e117.
- Ash A., Smith A., Maxwell D. Caesarean scar pregnancy. BJOG. 2007; 114(3): 253-63. https://dx.doi.org/10.1111/j.1471-0528.2006.01237.x.
- Silva B., Viana Pinto P., Costa M.A. Cesarean scar pregnancy: a systematic review on expectant management. Eur. J. Obstet. Gynecol. Reprod. Biol. 2023; 288: 36-43. https://dx.doi.org/10.1016/j.ejogrb.2023.06.030.
- Fu L., Luo Y., Huang J. Cesarean scar pregnancy with expectant management. J. Obstet. Gynaecol. Res. 2022; 48(7): 1683-90. https://dx.doi.org/10.1111/jog.15258.
- Чечнева М.А., Панов А.Е., Федоров А.А., Благина Е.И. Возможности ультразвуковой диагностики и ведения беременности в рубце на матке. SonoAce Ultrasound. 2017; 27: 3-10. [Chechneva M.A., Panov A.E., Fedorov A.A., Blagina E.I. Possibilities of ultrasound diagnosis and management of pregnancy in the uterine scar. SonoAce Ultrasound. 2017; 27: 3-10. (in Russian)].
- Министерство здравоохранения Российской Федерации. Клинические рекомендации. Внематочная (эктопическая) беременность. 2021. [Ministry of Health of the Russian Federation. Clinical guidelines. Ectopic pregnancy. 2021. (in Russian)].
- Сонова М.М., Гашенко В.О., Ласкевич А.В., Торубаров С.Ф. Эктопическая беременность в рубце на матке после кесарева сечения. Проблемы репродукции. 2018; 24(1): 42-7. [Sonova M.M., Gashenko V.O., Laskevich A.V., Torubarov S.F. The case of ectopic pregnancy in cesarean section scar. Russian Journal of Human Reproduction. 2018; 24(1): 42 7. (in Russian)]. https://dx.doi.org/10.17116/repro201824142-47.
- Сидоров А.Е., Гунин А.Г., Чернышов В.В. Отдаленные риски кесарева сечения: беременность в рубце на матке. Обзор литературы. Акушерство, гинекология и репродукция. 2017; 11(4): 48-56. [Sidorov A.E., Gunin A.G., Chernyshov V.V. Long-term risks of cesarean delivery: cesarean scar pregnancy. A systematic review. Obstetrics, Gynecology and Reproduction. 2017; 11(4): 48-56. (in Russian)]. https://dx.doi.org/10.17749/ 2313-7347.2017.11.4.048-056.
- Roberge S., Demers S., Berghella V., Chaillet N., Moore L., Bujold E. Impact of single- vs double-layer closure on adverse outcomes and uterine scar defect: a systematic review and metaanalysis. Am. J. Obstet. Gynecol. 2014; 211(5): 453-60. https://dx.doi.org/10.1016/j.ajog.2014.06.014.
- Терегулова Л.Е., Терегулов А.Ю., Хайрутдинова М.Р., Гаязов Д.Р., Савушкина Н.Ю. Ультразвуковая диагностика рубцовой беременности как основа дифференцированного подхода к органосохраняющему лечению. Практическая медицина. 2017; 2(103): 113-8. [Teregulova L.E., Teregulov A.Yu., Khairutdinova M.R., Gayazov D.R., Savushkina N.Yu. Ultrasound diagnosis of scar pregnancy as the basis for a differentiated approach to organ-preserving treatment. Practical Medicine. 2017; 2(103): 113-8. (in Russian)].
- Синчихин С.П., Павлов Р.В., Телегина И.В., Павлов В.Р. Эктопическая беременность в рубце на матке после кесарева сечения. Астраханский медицинский журнал. 2023; 18(2): 126-31. [Sinchikhin S.P., Pavlov R.V., Telegina I.V., Pavlov V.R. Ectopic pregnancy in the uterine scar after cesarean section. Astrakhan Medical Journal. 2023; 18(2): 126-31. (in Russian)]. https://dx.doi.org/10.29039/1992-6499-2023-1-126-131.
- Рыбалка А.Н., ред. Внематочная беременность: учебное пособие. 3-е изд. Симферополь: ООО «Эльиньо»; 2021. 160 с. [Rybalka A.N., eds. Ectopic pregnancy: a tutorial. 3rd ed. Simferopol: Elinyo LLC; 2021. 160 p. (in Russian)].
- Цхай В.Б., Яметов П.К., Нефедьева И.М., Леванович Е.В. Беременность в рубце на матке после кесарева сечения (описание cлучая). Проблемы репродукции. 2017; 23(2): 92-5. [Tskhaĭ V.B., Yametov P.K., Nefed’eva I.M., Levanovich E.V. Pregnancy in the scar after caesarean section (case report). Russian Journal of Human Reproduction. 2017; 23(2): 92-5. (in Russian)]. https://dx.doi.org/10.17116/repro201723292-95.
- Calì G., Timor-Tritsch I.E., Palacios-Jaraquemada J., Monteaugudo A., Buca D., Forlani F. et al. Outcome of Cesarean scar pregnancy managed expectantly: systematic review and meta-analysis. Ultrasound Obstet. Gynecol. 2018; 51(2): 169-75. https://dx.doi.org/10.1002/ uog.17568.
- Терегулова Л.Е., Терегулов А.Ю., Галимова И.Р., Гаязов Д.Р., Хайрутдинова М.Р. Случай диагностики и лечения беременности в рубце на матке после кесарева сечения с одновременным развитием нормального плода в полости матки на сроке 17 недель. Практическая медицина. 2017; 7(108): 173-6. [Teregulova L.E., Teregulov A.Yu., Galimova I.R., Gayazov D.R., Khairutdinova M.R. The case of diagnosis and treatment of uterine scar pregnancy after cesarean section with the simultaneous development of a normal fetus in the uterine cavity for a period of 17 weeks. Practical Medicine. 2017; 7(108): 173-6. (in Russian)].
- Коротовских Л.И., Коваль М.В., Богданова А.М., Литвина Л.Д., Цыпушкина В.В. Эктопическая беременность в рубце на матке после операции кесарева сечения: клинический случай. Пермский медицинский журнал. 2021; 38(5): 153-60. [Korotovskikh L.I., Koval M.V., Bogdanova A.M., Litvina L.D., Tsypushkina V.V. Cesarean scar ectopic pregnancy: clinical case. Perm Medical Journal. 2021; 38(5):153-60. (in Russian)]. https://dx.doi.org/10.17816/pmj385153-160.
- Курцер М.А., Бреслав И.Ю., Колотилова М.Л., Барыкина О.П., Скрябин Н.В., Курбатская О.Н. Неразвивающаяся беременность в рубце на матке после кесарева сечения: сложности диагностики. Акушерство и гинекология. 2023; 2: 160-4. [Kurtser M.A., Breslav I.Yu., Kolotilova M.L., Barykina O.P., Skryabin N.V., Kurbatskaya O.N. Non-developing pregnancy in the uterine scar after caesarean section: diagnostic difficulties. Obstetrics and Gynecology. 2023; (2): 160-4. (in Russian)]. https://dx.doi.org/10.18565/ aig.2022.214.
- Ravi Selvaraj L., Rose N., Ramachandran M. Pitfalls in ultrasound diagnosis of cesarean scar pregnancy. J. Obstet. Gynaecol. India. 2018; 68(3): 164-72. https://dx.doi.org/10.1007/s13224-016-0956-1.
- Rienhoff H.Y. Jr., Yeo C.Y., Morissette R., Khrebtukova I., Melnick J., Luo S. et al. A mutation in TGFB3 associated with a syndrome of low muscle mass, growth retardation, distal arthrogryposis and clinical features overlapping with Marfan and Loeys-Dietz syndrome. Am. J. Med. Genet. A. 2013; 161A(8): 2040-6. https://dx.doi.org/10.1002/ajmg.a.36056.
- Vial Y., Petignat P., Hohlfeld P. Pregnancy in a cesarean scar. Ultrasound Obstet. Gynecol. 2000; 16(6): 592-3. https://dx.doi.org/10.1046/ j.1469-0705.2000.00300-2.x.
- Morente L.S., León A.I.G., Reina M.P.E., Herrero J.R.A., Mesa, E.G., López J.S.J. Cesarean scar ectopic pregnancy - case series: treatment decision algorithm and success with medical treatment. Medicina. 2021; 57: 362. https:// dx.doi.org/10.3390/medicina57040362.
- Fylstra D.L. Ectopic pregnancy not within the (distal) fallopian tube: etiology, diagnosis, and treatment. Am. J. Obstet. Gynecol. 2012; 206(4): 289-99. https://dx.doi.org/10.1016/j.ajog.2011.10.857.
- Maymon R., Svirsky R., Smorgick N., Mendlovic S., Halperin R., Gilad K. et al. Fertility performance and obstetric outcomes among women with previous cesarean scar pregnancy. J. Ultrasound. Med. 2011; 30(9): 1179-84. https://dx.doi.org/10.7863/jum.2011.30.9.1179.
Supplementary files
